Evolution of infection control in Egypt: Achievements and challenges Maha Talaat, MD, a Amr Kandeel, MD, b Ossama Rasslan, MD, c Rana Hajjeh, MD, a,d Zoheir Hallaj, MD, e Nasr El-Sayed, MD, b and Frank J. Mahoney, MD a,d Cairo, Egypt; Atlanta, Georgia; and Geneva, Switzerland Background: The high prevalence of hepatitis C virus (HCV) infection in Egypt highlighted the urgent need for implementing infection control (IC) programs in Egypt. Objectives: The Ministry of Health and Population (MOHP), in collaboration with the US Naval Medical Research Unit No. 3, and the World Health Organization (WHO), developed a national plan to initiate an IC program with the objectives of improving quality of care and reducing transmission of hospital-acquired infections. Methods: The strategic plan for this program included setting up an organizational structure, developing IC national guidelines, training health care workers, promoting occupational safety, and establishinga system for monitoring and evaluation. Implemen- tation of the program started in late 2001. Results: The achievements to date include developing a national organizational structure, IC guidelines, and a comprehensive IC training program. To date, a total of 72 hospitals in 13 governorates have been enrolled in the program, and 235 IC professionals have been trained. Conclusions: Many challenges were faced, including administrative, financial, and motivational difficulties. Future plans include expansion of the program to cover all 27 governorates of Egypt and establishment of a surveillance system for hospital-acquired infections. The process of developing the IC program in Egypt may serve as a model for other resource-limited countries that seek to initiate similar programs. (Am J Infect Control 2006;34:193-200.) Infections acquired in health care settings have emerged as an important public health problem and are a leading cause of morbidity and mortality world- wide. They affect both developed and resource-poor countries and constitute a significant burden both for the patient and for the health care system. 1 A preva- lence survey was conducted, under the auspices of the World Heath Organization (WHO), in 55 hospitals from 14 countries representing 4 regions (Europe, East- ern Mediterranean, Southeast Asia, and Western Pacific). This survey revealed that an average of 8.7% of hospitalized patients developed hospital-acquired infections, with the highest frequencies of such infec- tions occurring among hospitals in the Eastern Medi- terranean and Southeast Asian regions (11.8% and 10%, respectively). 2,3 In the United States, it was estimated that hospital- acquired infections were responsible for 0.7% to 10.1% of all deaths in the early 1990s. 4 Furthermore, because of prolonged hospital stays and increased morbidity, these infections were found to contribute significantly to increased costs of health care in the United States and Europe. 5-7 In resource-poor coun- tries, limited data exist on the morbidity, mortality, and costs associated with the transmission of hospi- tal-acquired infections. During the past 2 decades, health care delivery sys- tems in Egypt have experienced many changes, with rapid introduction of new technologies, an increase in the numbers of invasive procedures, and an increase in provision of complex services, such as intensive care. These changes have often occurred without devel- opment of appropriate safeguards to prevent hospital- acquired infections. In addition, the growing Egyptian population has strained the capacity of public sector fa- cilities to provide quality services. This report describes the evolution of a program to promote infection control in Egypt, within the context of a rapidly evolving health care system and with its many challenges and con- straints. Prior to implementing this program, infection control was not a well-developed discipline in Egypt, and few health care facilities had infection control From the US Naval Medical Research Unit No. 3, Infection Control Unit, Disease Surveillance Program, Cairo, Egypt a ; Ministry of Health and Population, Cairo, Egypt b ; Ain Shams University and Egyptian Soci- ety for Infection Control (ESIC), Egypt c ; US Centers for Disease Con- trol and Prevention, Atlanta, GA d ; and World Health Organization, Geneva, Switzerland. e Reprint requests: Maha Talaat, MD, Head, Infection Control Unit, US Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835- 0007. E-mail: talaatm@namru3.med.navy.mil or talaatm20@yahoo.com. Supported by USAID, Work Unit No. 80000.000.000.E0022; the Ford Foundation; and the World Health Organization. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, the US Government, or the Egyptian Ministry of Health and Population. 0196-6553/$32.00 Copyright ª 2006 by the Association for Professionals in Infection Control and Epidemiology, Inc. doi:10.1016/j.ajic.2005.05.028 193